Long-Term Use More Likely With Opioids vs NSAIDs for Low Back Pain

Researchers identified patterns of opioid and NSAID use among patients with low back pain.

ATLANTA, Georgia – Rates of long-term opioid use for chronic noncancer pain have increased over the last 15 years, though there is scant evidence supporting this practice.1 Meanwhile, the number of overdose deaths from prescription opioids more than tripled during a similar time period: between 2001 and 2014.2 The ongoing use of nonsteroidal anti-inflammatory drugs (NSAIDs) has also been linked with risks, including gastrointestinal bleeding and kidney disease. Despite practices to the contrary, opioids and NSAIDs are both intended for short-term use. In a study that was partially funded by a grant from the National Institutes of Health, researchers at Henry Ford Health System in Detroit recently explored whether the initial prescription choice between these two medications influenced patterns of long-term use.1

Using electronic medical records and insurance claims, the investigators compared patterns of opioid and NSAID use among patients who received new prescriptions for either medication within 2 weeks of diagnosis of new-onset, noncancer-related lower back pain between 1998 and 2012. “Exclusion criteria were any prior back pain diagnosis, procedure, or surgery; any prior diagnosis of diabetes, cancer, gastrointestinal bleeding, or renal insufficiency; or any prior recorded opioid or NSAID prescription fill,” according to the paper presented at the 2016 Annual Meeting of the American Psychiatric (APA) in Atlanta, Georgia. The researchers tracked continuous medication use for 1 year after the initial prescription, and they used logistic regression to adjust for age, sex, and race/ethnicity. To account for patients whose records indicated that they had stopped and then restarted their medication during the study period, analyses were performed to adjust for the amount of time between discontinuation and restart.

Results show that from the sample of 3747 adult patients, 387 had received new prescriptions for opioids, while 3360 had received new prescriptions for NSAIDs after being diagnosed for the first time with lower back pain. Compared with 2.1% of new NSAID users, 8.5% of new opioid users continued using the medication over the 1-year period, and persistent “use for 1 year following initiation was 3 times more common among opioid users when compared with NSAID users (adjusted odds ratio [OR]: 3.06, P<.001),” the authors wrote. Additionally, among patients who stopped and restarted their medication, nearly twice the number of opioid users continued use for 1 year compared with NSAID users (7.9% vs 4.4%; OR: 1.87, P=.044).

These findings suggest that in “patients with new-onset, noncancer-related low back pain, the choice of initiating opioid medication must be examined judiciously,” and education about the intended duration of use is warranted, the authors wrote. “Clinically, these findings have particular relevance for risk prevention, given that opioids are associated with a serious long-term risk of addiction,” they concluded.

Click here for more research from the 2016 Annual Meeting of the American Psychiatric Association.